When removing breast is not the answer

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Photos:Celebrities battle cancer

Jaime "Taboo" Gomez of the Black Eyed Peas revealed in November that he survived testicular cancer.

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Photos:Celebrities battle cancer

Actor Ben Stiller revealed in October he was diagnosed with prostate cancer in 2014. The tumor was surgically removed three months later, in September 2014, and Stiller has been cancer-free since.

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Photos:Celebrities battle cancer

In August 2015, actress Shannen Doherty confirmed to People that she is undergoing treatment for breast cancer. She went public with the news after TMZ reported she was suing a former business manager, accusing her of letting the star's health insurance lapse. In August 2016, she said that the cancer has spread and she's had a single mastectomy.

Former Rolling Stone bass player Bill Wyman has been diagnosed with prostate cancer. An original member of the band, which formed in 1962, Wyman left the group in 1992. The 79-year-old is expected to make a full recovery.

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Photos:Celebrities battle cancer

Hugh Jackman posted a photo to Facebook indicating he had been treated for skin cancer for at least the fourth time since 2013.

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Photos:Celebrities battle cancer

Grateful Dead bassist Phil Lesh took to Facebook to reveal he's battling bladder cancer. In an apology to fans for canceling a pair of concerts, Lesh announced he's received treatment at the Mayo Clinic and his prognosis is good.

Def Leppard guitarist Vivian Campbell, 52, pulled out of the band's tour in June after his Hodgkin's lymphoma returned.

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Photos:Celebrities battle cancer

Tommy Chong of Cheech & Chong, who was diagnosed with prostate cancer in 2012, told Us magazine that he is undergoing treatment for rectal cancer. As he did for the prostate cancer, he's using marijuana to take the edge off: "I'm using cannabis like crazy now, more so than ever before," he told the magazine.

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Photos:Celebrities battle cancer

Sir John Hurt, known for performances in "Alien," "The Elephant Man" and the Harry Potter movies, told the British Press Association that he has pancreatic cancer. The disease is in its early stages, he said, and he is "more than optimistic about a satisfactory outcome, as indeed is the medical team."

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Photos:Celebrities battle cancer

Actress Rita Wilson, who can be seen on HBO's "Girls," revealed April 14 that she is fighting breast cancer and has undergone a double mastectomy. She thanked her family, including husband Tom Hanks, and doctors for their support in a statement to People magazine.

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Photos:Celebrities battle cancer

Fans of singer Morrissey knew the star had been ill after he canceled some U.S. tour stops in June, but it appears the performer has been battling cancer. "They have scraped cancerous tissues four times already, but whatever," Morrissey said in an interview with Spanish-language outlet El Mundo. "I am aware that in some of my recent photos I look somewhat unhealthy, but that's what illness can do. I'm not going to worry about that."

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Photos:Celebrities battle cancer

When former "Good Morning America" host Joan Lunden learned she was facing an "aggressive" form of breast cancer, she was determined to face her health battle head on. Knowing she would need chemotherapy, Lunden decided to remove her familiar blond hair before her locks could be affected by the treatment. "You know it's going to happen one of these days and you are wondering how or when," Lunden explained to People magazine, which she posed for without her wig in September. "So I just owned it."

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Former "Dancing With the Stars" co-host Samantha Harris was diagnosed with breast cancer and underwent a double mastectomy. Harris told People magazine she detected a lump during a self-exam and then followed up with a specialist after receiving a clean mammogram.

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Photos:Celebrities battle cancer

Actress Brittany Daniel of "Sweet Valley High" and "The Game" fought stage IV non-Hodgkin's lymphoma. Daniel recalls in an issue of People magazine that her 2011 diagnosis "happened so suddenly," but she was able to face it with the support of her family.

ABC's Amy Robach found out she had breast cancer in November 2013 after she had a mammogram done live on "Good Morning America" for cancer awareness month.

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Radio personality Robin Quivers quietly battled cancer for months, but she had happy news to share with "Howard Stern" listeners in September 2013. On the show, Quivers revealed that her doctors believe she's cancer-free after receiving treatment, including chemotherapy.

Sharon Jones held off plans to tour and release a new album with the Dap-Kings after being diagnosed with stage 1 bile duct cancer in 2013.

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Photos:Celebrities battle cancer

Michael Douglas offered some interesting insight as to how he may have developed the throat cancer that he was diagnosed with in August 2010. Douglas later told the "Today" show that his tumor was gone.

Actress Christina Applegate had a bilateral mastectomy in 2008. Doctors had diagnosed her with cancer in her left breast and offered her the options of either radiation treatment and testing for the rest of her life or removal of both breasts.

KISS band member Peter Criss sat down with CNN's Elizabeth Cohen in 2009, a year after his battle with breast cancer. The musician said he wanted to increase awareness of the fact that men can also get the disease.

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Cynthia Nixon not only joined the cast of Showtime's "The Big C," about a woman battling the disease, and portrayed a woman with cancer in the Broadway play "Wit" -- Nixon was diagnosed with breast cancer in 2006.

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Photos:Celebrities battle cancer

Zoraida Sambolin was diagnosed with breast cancer in April 2013, and she chose to have a double mastectomy. Sambolin said that Angelina Jolie's New York Times opinion piece about undergoing the procedure gave her courage to share her story.

"Three's Company" star Suzanne Somers spoke with CNN's Piers Morgan in 2012 about her stem cell surgery and her bout with breast cancer. She was diagnosed in 2001, which is when she began researching alternative methods to reconstructive surgery.

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Olivia Newton-John was diagnosed in 1992, and the singer has become an advocate for breast self-examination.

Australian singer Kylie Minogue was only 36 when she was diagnosed with breast cancer in 2005.

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Story highlights

Sarah Hawley: Jolie, who's high risk, a good candidate for mastectomy, but word of caution

She says women with cancer in one breast increasingly having other breast removed too

She says risk of cancer in healthy breast is less than 1%; overtreatment a concern

Hawley: Women need control over health decisions, but must have accurate info on choices

Angeline Jolie, who has stated that she is a carrier of the gene mutation BRCA1, appears to have been a good candidate for the bilateral prophylactic mastectomy she underwent recently to remove both of her breasts. In Jolie's case -- as with others who have openly discussed a similar action, such as Miss American contestant Allyn Rose and celebrity Sharon Osbourne -- the decision is appropriate: Having a genetic mutation, as these women do, puts a woman at very high risk for developing breast cancer in her lifetime.

But it possible that these very public decisions could lead more women with cancer diagnosed in one breast to consider having their second, nonaffected breast removed. This is called contralateral prophylactic mastectomy and it is on the rise in the U.S. Data from large cancer registry studies, for one example, have shown that the overall rate of CPM among women with stage I, II or III breast cancer signiﬁcantly increased from 1.8% in 1998 to 4.5% in 2003. Looking only at patients treated with mastectomy, the CPM rate grew from 4.2% in 1998 to 11.0% in 2003.

It is important, on the news of Jolie's decision, to caution women that CPM should be done only for the same reason as bilateral prophylactic mastectomies -- the presence of BRCA1 OF BRCA2. While many women who choose CPM do carry one of these genes, our research suggests that most do not.

Sarah Hawley

Considered in the context of history, this is a jarring development. Back in the 1970s, women with breast cancer and their supporters pushed to have the option of breast conserving surgery (BCS or "lumpectomy") made available as an option to treat breast cancer.

They argued then that they should have access to a less invasive option than mastectomy (surgery to remove all breast tissue), particularly when randomized trials suggested the two treatments gave women the same chance of long-term survival. Yet in the United States we now find ourselves on the opposite end of the spectrum, with patients largely driving decisions -- electing to undergo this most extensive treatment option for breast cancer.

It would be almost unheard of for a woman without cancer to have a bilateral prophylactic mastectomy, as Jolie did, unless she had a genetic mutation.

So why would a woman who has cancer in one breast choose to have a second, healthy breast removed? Our research suggests that patients are worried about recurrence. But for the average breast cancer patient who has neither the BRCA1 or BRCA2 gene mutation nor a close relative with breast cancer (Jolie's mother, for example, died from ovarian cancer), the risk of a new breast cancer in the nonaffected breast is less than 1%.

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Having the nonaffected breast removed will not translate into any additional survival benefit beyond what is conferred by treating the existing cancer. In fact, research has shown that many women who choose CPM could have been treated with only a lumpectomy, plus radiotherapy, in the affected breast.

Given the extent of the procedure, that CPM is done on patients without clinical reason raises strong concerns about overtreatment. This is perhaps the only example of removing a nonaffected organ based on what appears to be patient misunderstanding of the potential benefit of the surgery.

It's unlikely that a surgeon would agree to remove the entire colon of a patient with resectable colon cancer because the patient was worried about getting more colon cancer. Similarly, it is difficult to imagine a man with testicular cancer requesting to have both the affected and nonaffected testicles removed.

In this era of patient-centered care, women do need to feel empowered to make the choices that are best for them in treating their breast cancer. Yet because these choices are so difficult, it is imperative that they be based on accurate understanding of the risks and benefits of treatment. Perhaps we need to turn our attention to helping women remember why they advocated for less invasive options nearly 40 years ago.